Paeds Cardio Flashcards
(116 cards)
1
Q
What is the most common congenital heart defect?
A
Ventricular Septal Defect (VSD)
2
Q
The majority of VSDs are caused by a defect in which part of the ventricular septum?
A
membranous top bit
as opposed to muscular bottom bit
3
Q
Which way do most VSDs shunt?
A
left to right
4
Q
Which are the three types of CHD which shunt left-to-right? (breathless)
A
VSD, ASD, PDA
5
Q
Which are the two types of CHD which shunt right-to-left? (blue)
A
Tranposition of Great Arteries
Tetralogy of Fallot
6
Q
What is main symptom of left-to-right shunts?
A
breathless
7
Q
What is main symptom of right-to-left shunts?
A
blue
8
Q
Auscultation of VSD?
A
pansystolic murmur @LLSE
radiating to axilla
9
Q
What proportion of VSDs close spontaneously?
A
50%
10
Q
In later childhood, some VSDs can start shunting right-to-left instead, causing deoxygenated blood from the right heart to flow around the body, causing cyanosis. What’s this called?
A
Eisenmenger’s
happens due to gradual increase in pulmonary vascular resistance
11
Q
Name 4 risk factors for VSD.
A
foetal alcohol
Down’s
maternal diabetes
rubella
12
Q
Why does VSD cause an increased risk of endocarditis?
A
turbulent flow
advise good oral hygeine!
13
Q
What might ECG show in VSD?
A
LV hypertrophy (left-to-right shunt)
or biventricular
14
Q
CXR can normal in small VSD. What would CXR show in large VSD?
A
cardiomegaly
pulm oedema
15
Q
What is the medical management of VSD? (x3)
buy time and reduce symptoms
A
diuretics + ACE inhibitors + extra calories
furosemide, captopril
16
Q
What drug is used when a child has congestive HF?
A
digoxin
17
Q
What is the surgical management of VSD?
A
surgical or catheter repair
18
Q
Why is it important to remain good dental hygeine if you’re a child with a VSD (repaired or not)?
A
risk of infective endocarditis
19
Q
7 week old infant presents with poor weight gain, shortness of breath, and poor feeding. On auscultation, pansystolic murmur on lower left sternal edge, radiating to axilla. What investigations?
A
suspect VSD:
- ECG
- Echo
- consider CXR
also septic screen (bloods)
20
Q
What is the gold standard investigation for diagnosis of VSD?
A
Echo
21
Q
The main causes of heart problems in neonates are to do with obstructed systemic circulation. For example (x2)
A
coarctation of the aorta
hypoplastic left heart syndrome
22
Q
The main causes of heart problems in infants are to do with high pulmonary blood flow. For example (x3)
A
VSD, ASD, PDA
23
Q
The main causes of heart problems in older children are to do with actual heart failure. :( For example (x3)
A
Eisenmengers
Cardiomyopathy
Rheumatic heart disease
24
Q
We can split congenital heart defects into left-to-right (VSD, ASD, PDA) or right-to-left (ToF, TGA) shunts….
But in which defect is there “common mixing”?
A
AVSD
atrioventriuclar septal defect
25
2 causes of outflow obstruction in well child.
aortic stenosis
| pulmonary stenosis
26
What is cause of outflow obstruction in collapsed neonate?
coarctation of the aorta
27
Most ASDs are as a result of which bit of atrial septum failing to close?
ostium secundum
28
Ausculation of ASD.
ejection systolic murmur @ULSE
radiating to back
+ fixed second heart sound
(extra flow thru pulm valve + pulm valve can't close)
29
What is the risky complication of ASD?
```
paradoxical embolism
(crosses from pulm to systemic circ via ASD) --> stroke
```
30
Most ASDs are ASYMP. But some ASDs present late with breathlessness, big right heart and palpitations. True or false?
true
most ASDs are asymp tho
31
Apart from ASD, what else can cause hole in atrial septum?
patent foramen ovale
32
When is the foramen ovale usually meant to close?
when baby takes her first breath
33
Where is the foramen ovale and why is it a thing?
hole in atrial septum
allow oxygenated blood from placenta to go from right to left
bypassing the fetal lungs, which don't work until first breath
34
Where is the ductus arteriosus?
pulm artery to aorta
35
Why is the ductus arteriosus a thing?
bypassing the foetal lungs
| catches any right to left that the foramen ovale has missed
36
What is management of ASD?
surgical or catheter repair
37
Auscultation of PDA.
continuous machinery murmur @ULSE
38
Which babies does PDA usually affect?
preterms
39
A preterm baby has cyanosis only in the lower extremities. What do you suspect?
PDA
40
Why does PDA only cause cyanosis in lower extremities?
ductus arteriosus is downstream from subclavian arteries (which supply head and upper limbs)
41
Which hormone keeps ductus arteriosus patent? :(
prostaglandin E2
42
Which drug can do pharmacalogic closure of a PDA?
IV indomethacin
| or ibuprofen
43
What is a AVSD (atrioventricular septal defect)?
the centre of the heart is missing :(
44
Which kids are affected by AVSD?
those with Down's syndrome
45
In which congenital heart defect would they be breathless AND blue, with rapid symptoms?
AVSD
46
In general, what is the management for left-to-right shunts?
stabilise
increase calorie intake (NG feeds?)
diuretics + ACE inhibitors
...surgical or catheter repair
47
The aorta swaps places with the pulmonary artery. What's this called?
Transposition of Great Arteries
48
What happens in Transposition of the Great Arteries?
Aorta swaps places with the pulmonary artery
(blood from right heart goes out to body via aorta, never oxygenated)
(blood from left heart goes out to lungs via pulm artery, never deoxygenated)
:/
49
Where is ductus venosus?
umbilical vein to IVC
50
In which congenital heart defects do the pulmonary and systemic circulations stay separate? :(
Transposition of the Great Arteries
(blood from right heart goes out to body via aorta, never oxygenated)
(blood from left heart goes out to lungs via pulm artery, never deoxygenated)
51
What is the cause of death in Transposition of the Great Arteries
deep hypoxia and lactic acidosis
52
What is the most common CYANOTIC congenial heart defect?
Tetralogy of Fallot
53
What is the definitive investigation for Transposition of the Great Arteries?
Echo
| shows aorta and pulm artery wrong way round
54
What sign might CXR show in Transposition of the Great Arteries?
"egg on a string"
| narrowed superior mediastinum
55
Describe the management of Transposition of the Great Arteries.
```
Balloon Sepostomy (to allow emergency mixing)
then surgical correction
```
(long term complications of dodgy heart and neuro-dev abnormalities)
56
Within the first 24hrs of birth, a baby boy is cyanosed and has really low sats. ABG shows resp acidosis. He then collapses. What is the likely cause and how would you confirm this?
Transposition of the Great Arteries
Echo
(hypoxia and lactic acidosis)
57
What are the four abnormalities in Tetralogy of Fallot?
1. Pulm stenosis
2. RV hypertrophy
3. VSD
4. Aorta overriding VSD
58
Which chromosomal abnormality is associated with Tetralogy of Fallot?
DiGeorge syndrome
| also CHARGE syndome
(also foetal alcohol syndrome)
59
What is the chromosome deletion in DiGeorge syndrome?
22q11 deletion
60
A 5 week old presents with clubbing, feeding difficulty and weight faltering. He deteriorates and starts going blue. You hear a pansystolic murmur at the lower left sternal edge, and an ejection systolic murmur at the upper left sternal edge. What do you suspect?
Tetralogy of Fallot
pansystolic LLSE = VSD
ejection systolic ULSE = pulm stenosis
61
Sepsis should be on the differential for any infant with resp distress and hypoxia. True or false?
true
62
What causes "Tet spells" in Tetralogy of Fallot? (this is when they become hypercyanotic when active)
hypoxia
they squat down to kink femoral arteries, change pressure and reverse shunt.
63
What are the symptoms of a "tet spell"?
sudden breathlessness
increasing cyanosis
lots of crying
64
What bloods might you do if you suspect genetic abnormality causing Tetralogy of Fallot?
chromosomal microarray
65
What would ECG show in Tetralogy of Fallot?
RV hypertrophy (right-to-left shunt)
66
What would CXR show in Tetralogy of Fallot?
boot-shaped heart
67
What causes the boot shaped heart sign on CXR in Tetralogy of Fallot?
RV hypertrophy
68
What is gold standard for confirming diagnosis of Tetralogy of Fallot?
Echo
69
What drug can be given in "tet spells" ?
Propanolol
70
What is the management of Tetralogy of Fallot?
manage tet spells (propanolol, squatting, BT shunt)
| then perhaps definitive surgical repair
71
BT shunt can help reduce tet spells from hypoxia before definitive repair of Tetralogy of Fallot. What does it stand for?
Blalock-Taussig
72
85% children with surgically repaired Tetralogy of Fallot now survive to adulthood. How long do they need follow up?
lifelong
73
What are the three main causes of outflow obstruction in kids?
aortic stenosis
pulm stenosis
coarctation of the aorta
74
Blood gets to top half of body but not bottom half, causing radio-femoral delay. What is this?
coarctation of aorta
75
What does coarctation mean?
narrowing
76
A newborn has weak femoral pulses. What should FLASH across your mind?
coarctation of the aorta
| narrowing is usually downstream of subclavians
77
Which congenital heart defect is associated with Turner's syndrome?
coarctation of aorta
78
Asymptomatic murmurs in otherwise well neonates. What outflow obstructions do you think of?
aortic stenosis
| pulm stenosis
79
What kind of pulse would you feel in a child with aortic stenosis?
slow rising pulse (parvus + tardus)
80
What would an ECG/Echo show in aortic stenosis?
LV hypertrophy
81
Ausculation in aortic stenosis.
ejection systolic murmur in upper right sternal edge
| radiating to carotids
82
Ausculation in pulm stenosis.
ejection systolic murmur in upper left sternal edge
| radiating to back
83
What would an ECG/Echo show in pulm stenosis?
RV hypertrophy
| sometimes felt as heave in pulm stenosis
84
Which other congenital heart defects can result in pulm stenosis?
ASD
| Tetralogy of Fallot
85
Pulmonary stenosis is associated with which genetic disorder?
Noonan syndrome
86
Noonan syndrome can be a cause of pulmonary stenosis. Which chromosome is usually the problem?
chromosome 12
87
As well as Tetralogy of Fallot, DiGeorge syndrome can also cause Truncus Arteriosus. What is this?
aorta and pulm artery don't properly separate
88
Which congenital heart defects are most strongly associated with foetal alcohol syndrome?
ASD
| VSD
89
Which congenital heart defect is most strongly associated with Down's syndrome?
AVSD
| also Tet Fallot, VSD
90
Which congenital heart defect is most strongly associated with Turner's syndrome (45,X)?
Coarctation of the aorta
91
What is a thrill?
THIS REVISION! JOKE.
A palpable murmur
92
What is a heave?
hypertrophy
93
There is ejection systolic murmur at the upper left sternal edge, radiating to the back, and parasternal heave. Suspect?
pulm stenosis
| heave is from RV hypertrophy
94
Pulmonary stenosis might be a defect on its own, or a part of which other congenital heart defects?
ASD
| Tetralogy of Fallot
95
Aortic stenosis is ejection systolic murmur at upper right sternal edge. Where might this radiate to?
carotids
96
Slow rising pulse in....
aortic stenosis
97
You feel a thrill over the carotids. What FLASHES across your mind?
aortic stenosis
98
Pansystolic murmur at lower left sternal edge. What might this be and where might it radiate?
VSD
| radiating to axilla
99
Ejection systolic murmur at upper left sternal edge. What might this be and where might it radiate?
pulm stenosis
radiating to back
(+ parasternal heave: RV hypertrophy)
100
Differentials for strawberry tongue?
KAWASAKI
SCARLET FEVER
(oral allergy syndrome!)
(toxic shock)
101
What are the criteria called for diagnosing Kawasaki?
Crash and Burn!
102
Tell me the Crash and Burn criteria for diagnosing Kawasaki.
```
Conjunctivitis
Rash
Adenopathy (lymph)
Strawberry tongue (+red throat, cracked lips)
Hands and feet
```
Burn = fever (lasting >5ds)
103
Describe me the conjunctivitis in Kawasaki.
Bloodshot eyes with limbus sparing
104
Describe me the 'hands and feet' in Kawasaki.
red and swollen palms + soles
| peeling of fingers + toes
105
Does the fever in Kawasaki typically resolve with anti-pyretics?
Nope.
106
To get a diagnosis of Kawasaki, how many of the Crash and Burn criteria do you need?
4 symptoms + fever lasting >5ds
| doesn't meet all criteria = 'incomplete Kawasaki'
107
What would urine show in Kawasaki?
sterile pyuria
| increased WCC but no obv infection
108
Tell me what Kawasaki disease actually is please thank you :)
Vasculitis
of coronary arteries
but also large/medium size arteries throughout body
immune system attacks artery endothelial cells
109
Which age group does Kawasaki disease affect?
under 5s
| esp 1yr olds
110
Kawasaki disease is one of the few indications for the use of aspirin in children. Why is aspirin not normally used?
risk of Reye's syndrome
(brain and liver injury)
(after viral illness during which aspirin was administered)
111
In Kawasaki disease, kids often have raised WCC, with 'shift to the left'. What does this mean?
more immature WBCs than normal
112
What is the investigation to diagnose Kawasaki?
clinical diagnosis only!
| raised WCC, ESR/CRP, liver enzymes, plts
113
You've diagnosed Kawasaki clinically. What investigations would you want to check out?
bloods - (raised WCC, ESR/CRP, liver enzymes, plts)
urine - (sterile pyuria)
echo - (coronary artery involvement?)
114
What is the management of Kawasaki?
IV immunoglobulin
| aspirin
115
Why do you follow up Echo of Kawasaki six wks later?
check for coronary artery aneurysm/clots, may need warfarin
116
Kawasaki may resolve untreated. But 25% of children get...
coronary artery aneurysms
